Reimbursing Chronic Care Management (CCM) Wednesday, October 29th, 2014 Disclaimer: Nothing that we are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices презентация

are sharing is intended as legally binding or prescriptive advice. This presentation is a synthesis of publically available information and best practices.

so why were Care Management programs unpopular?

Lack of Payment
Most payers bundle payment for non-face-to-face interaction.
Costs
Staff
Technology
Time
Software Limitations
Care Management limitations in PM systems and integrated tools were lacking

Care Management services Effective January 1, 2015.

CMS acknowledged that 75% of our healthcare spending is directly related to chronic conditions. It sends a clear message that the costs associated with chronic disease drives the decision to encourage care management in our society.

into the E&M codes. It has since been recognized that the items were under valued and an important part of the care management of the patient:

Work that includes answering patient phone messages
Work that includes answering patient electronic messages
Sorting through formulary changes
Responding to labs or consultation recommendations
Providing weekend coverage.
Providing night emergency coverage

non-face-to-face chronic care management services for Medicare beneficiaries
Bundled
When Billed with the following services:
Home Health
Hospice
TCM
Nursing Home
Criteria
Medicare patient
Expected to live 12 months or until death
Multiple, significant chronic conditions (two or more)

released in November

Submission
Once per month, per qualified patient provided that medical needs of the patient involve the following as it relates to the care plan:
Establishing
Implementing
Revising
Monitoring

care management services were explained and accepted by the patient
Document Time and Service Provided
A written agreement that electronic communication of the patient’s information with other treating providers is part of care coordination
Information about the availability of the services from the practitioner
A written or electronic copy of the care plan that is provided to the beneficiary and recorded in the electronic health record (EHR).

the list below are identified as expectations for CCM:
Continuity of care with a clinician or practice
Care management that provides the following:
A systematic assessment of medical, functional, and psychosocial needs
A system-based approach for timely delivery of preventive services
Medication reconciliation
prescription and nonprescription
review of interactions and adherence

all care transitions
An EHR that is available 24/7 to both the the caregiver as well as the patient.
Opportunities for patient-to provider communication via telephone or secure asynchronous NF2F messaging

Begin the communication
Establish your written protocols
Identify the appropriate staff who comprise your clinical care management team.
Pursue PCMH designation
Establish your strategy